CTICasesAortic Intramural Hematoma
Imaging findings
Chest CT angiography demonstrates a large Type A aortic dissection/intramural hematoma (IMH) characterized by eccentric wall thickening and intramural blood extending from the aortic root to the arch and involving the innominate and right carotid arteries. A focal intimal breach (contrast leak) is present in the ascending aorta, and there is retrograde blood tracking along the left pulmonary artery.
Key takeaways
Aortic intramural hematoma (IMH) is an acute aortic syndrome characterized by hemorrhage within the media of the aortic wall without a patent false lumen. On CT, it presents as high-attenuation wall thickening. A focal intimal breach represents a small tear allowing communication with the lumen. IMH can track retrogradely along the pulmonary artery sheaths, mimicking pulmonary artery pathology, and Type A requires urgent surgical repair.
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